The usefulness of prostate specific antigen density as a screening method for prostatic carcinoma.

Prostate specific antigen (PSA) has been used extensively for monitoring the progression of prostatic cancer since its discovery in 1979. Unfortunately the measurement of PSA in serum is not sufficiently specific for early detection of prostatic carcinoma (CaP) as it is secreted by normal as well as hyperplastic or cancerous prostatic tissue. As serum PSA is the reflection of the number of prostatic epithelial cells, a small cancerous prostate gland having increased number of cells per unit volume leaks more PSA in serum than a benign, large gland. Thus the concept of PSA density (PSAD) has been proposed (the quotient of serum PSA divided by the volume of prostate in cubic centimeter) as an indicator for prostatic malignancy. In the present study pre-operative PSAD values of 65 cases of prostatic diseases were calculated [54 cases of benign prostatic hyperplasia (BPH) and 11 cases of C3P]. Serum PSA was measured by enzyme linked immunosorbent assay (ELISA) method and the prostatic volume was measured by transrectal ultrasonography (TRUS). Although 8 cases of BPH (14.8%) had raised PSA level, abnormal PSAD (0.1 or above) was noted in only 3 cases. All cases having PSAD value above 0.2 had carcinoma. The PSAD value above 0.1 in cases of CaP was found to be significant (p<0.001). By using PSAD as screening test the sensitivity increased from 85.1% to 94.4% and positive predictive value increased from 55.5% to 75%, compared to the detection of carcinoma by measuring PSA alone. The present study concludes that PSAD is more useful for prediction of CaP and the need of prostatic biopsy for early detection.

Hepatic histology in chronic liver disease in hepatitis B surface antigen positive cases.

The spectrum of histological changes in needle biopsies of the liver tissue was analysed in 43 patients with chronic liver disease who were positive for hepatitis B surface antigen (HBsAg) in their sera. Majority of the patients were around 40 years and there was a male predominance. According to histopathological pattern, there were 18 (41.8%) cases of chronic active hepatitis, 16 (37.2%) cases of inactive cirrhosis, 3 (6.9%) cases of chronic persistent hepatitis and 2 (4.7%) cases of chronic lobular hepatitis and hepatoma each. Two (4.7%) cases could not be exactly categorised into any particular histological entity. The inflammation, hepatic cell necrosis and fibrosis were more marked in cases of chronic active hepatitis without past history of jaundice. Micronodular cirrhosis was the most common histological pattern in the study. Shikata orcein stain for detection of HBsAg in the hepatocytes was positive in 8 (18.6%) cases only.

Collision tumor of gastrointestinal tract.

A rare combination of multiple adenomatous polyps of the colon and carcinoid tumor of the ileum in a 54-year-old man is reported.